Facts About Infertility

  • Most experts define infertility as inability to get pregnant after one year of regular unprotected sex.
  • Most couples are sub-fertile, not infertile.
  • 1 in 7 couples have difficulty conceiving.
  • 94% of fertile women aged 35 years, and 77% of those aged 38 years, will conceive after 3 years of trying.
  • Female fertility starts to decline around the age of 25.
  • Major factors causing infertility:
    • Female factors 32.5%
    • Male factors 32.5%
    • Male and female factors 10.8%
    • Unexplained factors 23.1%
    • Other factors 1.1%
  • The most common medical causes of sub-fertility (infertility) are:
    • sperm issues: low count, poor morphology, low motility
    • ovulation failure due to conditions such as Polycystic Ovarian Syndrome (PCOS) or thyroid disease
    • damaged fallopian tubes
    • endometriosis
    • early ovarian failure (premature menopause)

Infertility Investigations (NICE Guidelines, 2004)

When should couples be investigated?

  • Couples having difficulty conceiving should be investigated after one year of regular unprotected sex.
  • Women aged 35 years or older or couples with suspected reasons for infertility (e.g. amenorrhea, oligomenorrhoea, pelvic inflammatory disease etc) should be referred for basic investigations earlier than one year.
  • Early specialist referral is indicated in couples with proved reasons for infertility (e.g. prior treatment of cancer or anatomical abnormalities).

What infertility investigations should be done?

  • Basic investigations. Usually done by GPs and may include:
    • physical examination of both partners,
    • female hormonal tests, such as FSH and LH (day 2-5 of menstrual cycle), Progesterone test (half way through luteal phase of your menstrual cycle), possibly Thyroid hormone levels (if thyroid disease is suspected), possibly Prolactin levels, and in men usually semen analysis, which if abnormal, would need to be repeated three months later.
    • all women should be checked for rubella antibodies, cervical smear (if not up to date) and chlamydia.
  • Secondary care investigations. Usually done by gynaecologists or fertility specialists and may include:
    • women may undergo ultrasounds examination, HSG or HyCoSy to check for blocked tubes or polycystic ovaries. Laparoscopy with or without dye may be done to check for endometriosis and other pelvic diseases.
    • men may undergo any of the following: microbiologic tests, sperm culture, endocrine tests, scans of urogenital tract or testicular biopsy.
  • Advanced tests. Usually carried out by fertility clinics. May include any of the following:
    • Advanced female hormonal tests, e.g. AMH.
    • Antral Follicle Count scan.
    • Hysteroscopy.
    • Advanced semen parameters tests, e.g. DNA fragmentation test.
  • "New Age" tests. Carried out by only a handful of fertility clinics in the UK. May include:
    • "Level 1 tests" include genetic, immune and thrombophilia screen. These tests are used in couples suffering repeated miscarriages or repeated implantation failure. Some experts believe these have no use in infertile couples, whilst other experts think all couples struggling to conceive should be routinely screened for these problems.
    • "Level 2 tests" or "Chicago tests" include Natural Killer (NK) cells test. The expert opinion is divided whether these are necessary. Research is being carried out into this area. But in the meantime anecdotal evidence suggests that for some couples these tests and subsequent specialist treatment is the only way to conceive.

Sub-fertility/ Infertility Treatment Options

  • Medication (e.g. Metformin to regulate insulin levels in PCOS or Clomiphene (Clomid) to induce super-ovulation)
  • Surgery to treat the underlying causes of infertility
  • Assisted Reproductive Technology (ART) treatment, such as:
    • IUI
    • IVF
    • ICSI
    • IVM
    • GIFT/ ZIFT
    • IMSI
  • Third party treatment options (egg/ semen/ embryo donation, surrogate)
  • Adoption



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